Intrauterine Fetal Demise What is intrauterine fetal demise? Intrauterine fetal demise is the loss of a fetus (unborn baby).

It is also called stillbirth or fetal death. Stillbirth occurs when a woman is 20 or more weeks pregnant.

What may increase the risk of stillbirth? If you have any of the following, tests may be done during your pregnancy to check the health of the fetus. Ask your caregiver about the following:

Smoking cigarettes, drinking alcohol, or use of illegal (street) drugs, such as cocaine, during pregnancy

Use of medicine to help you get pregnant or use of certain pain medicines during pregnancy

Obesity

Being 35 years old or older, or being a teenager

Health disorders such as diabetes, high blood pressure, cholestasis (liver disease), and a history of blood clots

Being pregnant with more than 1 fetus

Previous stillbirth

Fetal growth restriction (fetus is growing too slowly)

Injury during pregnancy, such as from a fall, car accident, or physical abuse

What may cause a stillbirth?

Problems with the placenta: The placenta is tissue inside the uterus. It gives the fetus oxygen and nutrients. The placenta can separate from the wall of the uterus. This is called placental abruption. Another problem that may occur is that the placenta does not grow normally. These problems can prevent the fetus from getting the oxygen and nutrients it needs to live.

Genetic diseases: Abnormal genes in a fetus can cause stillbirth.

Infection: Stillbirth can be caused by infection in the mother, the fetus, or the placenta. Infection can occur when bacteria travel from the vagina up to the uterus. Infections that may cause stillbirth include E. coli, rubella, chickenpox, parvovirus, and syphilis.

Problems with the umbilical cord: This cord connects the fetus with the placenta. The cord can become knotted, tangled, or wrapped around the neck of the fetus. Umbilical cord problems can prevent oxygen and nutrients from reaching the fetus, causing stillbirth.

Fetomaternal hemorrhage: During pregnancy, a small amount of blood may go from the fetus to the mother's bloodstream. In some cases, the fetus loses too much blood. This may occur with placental abruption. It may also occur with trauma to the mother's abdomen, such as being hit in the stomach. Fetal blood loss can cause fetal anemia (lack of red blood cells). Anemia can cause lack of oxygen, blood clotting problems, and stillbirth. What are the signs and symptoms of stillbirth?

You cannot feel the fetus kicking or moving

Bleeding from your vagina

Pain in your abdomen

How can caregivers learn if a stillbirth has occurred?

Ultrasound: This test uses sound waves to show pictures of the fetus on a monitor. Caregivers can see if there is a heartbeat and movement of the fetus.

Non-stress testing: This test is also called NST. Two belts placed across your abdomen record changes in the heart rate of the fetus when your uterus contracts (tightens).

Biophysical profile: This test uses ultrasound to check the heart rate, breathing, and body movements of the fetus. It also checks how much amniotic fluid you have. This is the fluid that surrounds the fetus in the womb.

Umbilical artery Doppler velocimetry: This test uses ultrasound to check the blood flow inside the umbilical artery. This artery carries blood from the fetus to the placenta. What treatment may be needed after a stillbirth?

You may naturally deliver the fetus. You may need medicine or a procedure to remove the fetus from your body. Caregivers will talk to you about the following options:

Medical induction of labor: Medicine is used to start labor and you deliver the fetus naturally.

Extra-amniotic Foley catheter induction of labor: A catheter (rubber tube) is inserted into the cervix. Medicine goes through the catheter. The medicine prepares the cervix for labor, or starts contractions (tightening of the uterus). The fetus is delivered through the vagina.

Dilation and evacuation (D and E): The cervix (opening to the uterus) is dilated, or made larger. The fetus is then removed through the vagina (birth canal).

Dilation and curettage (D and C): The cervix is dilated, and caregivers use tools to remove the fetus through the vagina. What other choices may I have after a stillbirth?

Caregivers will try to find the cause of the stillbirth. This information is important because it can answer your questions about the stillbirth, and may be used to help plan a future pregnancy. A test called an autopsy is when the fetus is examined to find the cause of death. Caregivers may look closely at the placenta and umbilical cord. You may also have samples of your blood taken for tests.

Discuss these tests with your caregiver. Even with testing, caregivers may not be able to find the cause of the stillbirth, but the results of the tests can still be helpful. Ask your caregiver how to learn the results of these tests, and when to have follow-up visits. What are the risks of a stillbirth?

You may have blood clotting problems if you keep a stillborn fetus inside you. You may also get an infection. These problems can be life-threatening. If you are pregnant with more than 1 baby, a stillbirth can be dangerous to the other unborn baby or babies. Other unborn babies may need to be delivered right away. Side effects of medicine used for treatment include heavy bleeding, pain, and fever. You may also vomit or have diarrhea.

Risks of inducing labor include infection, damage to the uterus, and heavy bleeding. If you lose too much blood, you may need a blood transfusion. Tissue may be left in the uterus after the fetus is delivered. Caregivers may need to do a dilation and curettage procedure to remove this tissue. Risks of extraamniotic Foley catheter induction include nausea, vomiting, diarrhea, fever, and headache. It may also damage the uterus. Risks of dilation and evacuation or curettage procedures include bleeding, infection, and damage to the uterus or cervix. What can I do to help myself and others cope after a stillbirth?

You and those around you may feel sad, helpless, guilty, or angry. The following may help you and others cope after a stillbirth:

Talk about your experience: It may help you to talk to someone about your feelings. Talk to your caregiver. He may be able to help you understand what happened. Talk with a family member, friend, or someone you trust. You may also want to join a support group. This is a group of people who have also had a stillbirth.

Give yourself time to grieve: Allow yourself and others time to mourn the loss of your baby. Deep sadness is common after a stillbirth. Talk to your caregiver if you or those around you are having trouble coping. Counseling (talk therapy) may be helpful. What should I know about my ability to have children in the future?

You are at a higher risk of having another stillbirth. Caregivers will work with you to plan future pregnancies. You may need tests during the pregnancy to check your unborn baby's health. The following are things that you can do before and during your next pregnancy to stay healthy:

Manage health conditions: Manage health conditions such as diabetes, high blood pressure, and blood clotting problems.

Quit smoking: Ask your caregiver for help if you are having trouble quitting.

Reach a healthy weight: If you are overweight, reach a healthy weight before you become pregnant again. Ask your caregiver for more information on how to lose weight safely.

Keep a healthy lifestyle: Do not drink alcohol while you are pregnant. Do not use street drugs. When should I contact my caregiver?

Contact your caregiver if:

You are pregnant and you have a fever or body aches.

You are pregnant and your unborn baby is moving less than usual.

You have questions about stillbirth. When should I seek immediate help?

If you are pregnant, seek care immediately or call 911 for any of the following:

Your unborn baby has stopped moving.

You have pain in your abdomen.

You are bleeding from your vagina.

You have a fever or trouble breathing.

You are dizzy or feel faint, or your heart is beating faster than usual.

You have fallen or been in a car accident, even if you think that you are not injured. If you had a procedure or are taking medicine after a stillbirth, seek care immediately or call 911 if: You are bleeding heavily.

You feel sick, are vomiting, have diarrhea, or have abdominal pain.

You have a fever.

You are depressed and feel like you cannot cope with what has happened.

A 32 year old gravida 1, para O woman at 38-39 weeks gestation was admitted to hospital after she experienced uterine contractions and had noticed reduced fetal movements. She was brought to the hospital at once. Internal Examination was done and FHRT was monitored. FHRT is not audible. Patient E was requested for a routine ultrasound and the intrauterine death of the fetus was diagnosed. cesarean section was indicated and performed.